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Leth TA, Nymark A, Knudtzen FC, Larsen SL, Skov MN, Jensen TG, Bek-Thomsen M, Jensen HB, Hovius JW, Skarphédinsson S, Møller JK, Andersen NS. Detection of Borrelia burgdorferi sensu lato DNA in cerebrospinal fluid samples following pre-enrichment culture. Ticks Tick Borne Dis 2023; 14:102138. [PMID: 36746091 DOI: 10.1016/j.ttbdis.2023.102138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/06/2023]
Abstract
Molecular methods for diagnosing Lyme neuroborreliosis (LNB) have shown suboptimal diagnostic sensitivities. The objective of this study was to improve the clinical sensitivity of PCR detection of Borrelia burgdorferi sensu lato spirochetes by inoculating cerebrospinal fluid (CSF) from patients suspected of LNB directly into culture medium at the time of lumbar puncture, with this pursuing enrichment of Borrelia spirochetes before PCR analysis. Adult patients with symptoms suggestive of LNB were prospectively enrolled at two hospitals in the Region of Southern Denmark. The CSF-culture samples were incubated for at least eight weeks. During this period, culture sample aliquots were analysed for the presence of Borrelia DNA by separate PCR protocols in two independent clinical laboratories. The included patients were diagnosed with definite (n=12) or possible (n=2) LNB, and non-LNB (n=171) based on clinical and paraclinical findings. Patients in the LNB and the non-LNB group had a median duration from symptom onset to lumbar puncture of 40 days (IQR [23-90] days) and 120 days (IQR [32-365] days), respectively. Pre-enrichment growth of Borrelia spirochetes was accomplished from three patients (21 %) in the LNB group. The positive culture samples were confirmed by both the digital droplet PCR and the real-time PCR methods employed. All CSF samples were PCR negative in the non-LNB group. The results of this study do not support the use of Borrelia-specific PCR as a general routine diagnostic tool in adults. Still, they suggest it may prove of additional value in selected patients with a limited time from symptom onset to sample collection.
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Affiliation(s)
- Trine Andreasen Leth
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Anita Nymark
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Fredrikke Christie Knudtzen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sanne Løkkegaard Larsen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Marianne N Skov
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Thøger Gorm Jensen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Malene Bek-Thomsen
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark
| | - Henrik Boye Jensen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark; Department of Neurology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark
| | - Joppe W Hovius
- Amsterdam UMC, location AMC, Center for Experimental and Molecular Medicine, Amsterdam Multidisciplinary Lyme Borreliosis Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sigurdur Skarphédinsson
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark; Research Unit of Infectious Diseases, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Nanna Skaarup Andersen
- Department of Clinical Microbiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark; Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, J.B. Winsløwsvej 21. 2., Odense DK-5000, Denmark; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit for Clinical Microbiology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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2
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van Gorkom T, Voet W, van Arkel GHJ, Heron M, Hoeve-Bakker BJA, Notermans DW, Thijsen SFT, Kremer K. Retrospective Evaluation of Various Serological Assays and Multiple Parameters for Optimal Diagnosis of Lyme Neuroborreliosis in a Routine Clinical Setting. Microbiol Spectr 2022; 10:e0006122. [PMID: 35404103 PMCID: PMC9241602 DOI: 10.1128/spectrum.00061-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
Laboratory diagnosis of Lyme neuroborreliosis (LNB) is challenging, and validated diagnostic algorithms are lacking. Therefore, this retrospective cross-sectional study aimed to compare the diagnostic performance of seven commercial antibody assays for LNB diagnosis. Random forest (RF) modeling was conducted to investigate whether the diagnostic performance using the antibody assays could be improved by including several routine cerebrospinal fluid (CSF) parameters (i.e., leukocyte count, total protein, blood-CSF barrier functionality, and intrathecal total antibody synthesis), two-tier serology on serum, the CSF level of the B-cell chemokine (C-X-C motif) ligand 13 (CXCL13), and a Borrelia species PCR on CSF. In total, 156 patients were included who were classified as definite LNB (n = 10), possible LNB (n = 7), or non-LNB patient (n = 139) according to the criteria of the European Federation of Neurological Societies using a consensus strategy for intrathecal Borrelia-specific antibody synthesis. The seven antibody assays showed sensitivities ranging from 47.1% to 100% and specificities ranging from 95.7% to 100%. RF modeling demonstrated that the sensitivities of most antibody assays could be improved by including other parameters to the diagnostic repertoire for diagnosing LNB (range: 94.1% to 100%), although with slightly lower specificities (range: 92.8% to 96.4%). The most important parameters for LNB diagnosis are the detection of intrathecally produced Borrelia-specific antibodies, two-tier serology on serum, CSF-CXCL13, Reibergram classification, and pleocytosis. In conclusion, this study shows that LNB diagnosis is best supported using multiparameter analysis. Furthermore, a collaborative prospective study is proposed to investigate if a standardized diagnostic algorithm can be developed for improved LNB diagnosis. IMPORTANCE The diagnosis of LNB is established by clinical symptoms, pleocytosis, and proof of intrathecal synthesis of Borrelia-specific antibodies. Laboratory diagnosis of LNB is challenging, and validated diagnostic algorithms are lacking. Therefore, this retrospective cross-sectional study aimed to compare the diagnostic performance of seven commercial antibody assays for LNB diagnosis. Multiparameter analysis was conducted to investigate whether the diagnostic performance using the antibody assays could be improved by including several routine (CSF) parameters. The results of this study show that LNB diagnosis is best supported using the detection of intrathecally produced Borrelia-specific antibodies, two-tier serology on serum, CSF-CXCL13, Reibergram classification, and pleocytosis. Furthermore, we propose a collaborative prospective study to investigate the potential role of constructing a diagnostic algorithm using multiparameter analysis for improved LNB diagnosis.
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Affiliation(s)
- Tamara van Gorkom
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, The Netherlands
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Willem Voet
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Gijs H. J. van Arkel
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, The Netherlands
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Michiel Heron
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - B. J. A. Hoeve-Bakker
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Daan W. Notermans
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Steven F. T. Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Kristin Kremer
- Centre for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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3
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Lager M, Wilhelmsson P, Matussek A, Lindgren PE, Henningsson AJ. Molecular Detection of Borrelia Bacteria in Cerebrospinal Fluid-Optimisation of Pre-Analytical Sample Handling for Increased Analytical Sensitivity. Diagnostics (Basel) 2021; 11:diagnostics11112088. [PMID: 34829435 PMCID: PMC8623531 DOI: 10.3390/diagnostics11112088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
The main tools for clinical diagnostics of Lyme neuroborreliosis (LNB) are based on serology, i.e., detection of antibodies in cerebrospinal fluid (CSF). In some cases, PCR may be used as a supplement, e.g., on CSF from patients with early LNB. Standardisation of the molecular methods and systematic evaluation of the pre-analytical handling is lacking. To increase the analytical sensitivity for detection of Borrelia bacteria in CSF by PCR targeting the 16S rRNA gene, parameters were systematically evaluated on CSF samples spiked with a known amount of cultured Borrelia bacteria. The results showed that the parameters such as centrifugation time and speed, the use of complementary DNA as a template (in combination with primers and a probe aiming at target gene 16S rRNA), and the absence of inhibitors (e.g., erythrocytes) had the highest impact on the analytical sensitivity. Based on these results, a protocol for optimised handling of CSF samples before molecular analysis was proposed. However, no clinical evaluation of the proposed protocol has been done so far, and further investigations of the diagnostic sensitivity need to be performed on well-characterised clinical samples from patients with LNB.
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Affiliation(s)
- Malin Lager
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Correspondence: ; Tel.: +46-(0)10-2425238
| | - Peter Wilhelmsson
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Andreas Matussek
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Laboratory Medicine, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway
| | - Per-Eric Lindgren
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Anna J. Henningsson
- Division of Clinical Microbiology, Laboratory Medicine (Region Jönköping County, 553 05 Jönköping, Sweden), Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; (P.W.); (A.M.); (P.-E.L.); (A.J.H.)
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
- Division of Clinical Microbiology, Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
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Abstract
Lyme borreliosis is caused by a growing list of related, yet distinct, spirochetes with complex biology and sophisticated immune evasion mechanisms. It may result in a range of clinical manifestations involving different organ systems, and can lead to persistent sequelae in a subset of cases. The pathogenesis of Lyme borreliosis is incompletely understood, and laboratory diagnosis, the focus of this review, requires considerable understanding to interpret the results correctly. Direct detection of the infectious agent is usually not possible or practical, necessitating a continued reliance on serologic testing. Still, some important advances have been made in the area of diagnostics, and there are many promising ideas for future assay development. This review summarizes the state of the art in laboratory diagnostics for Lyme borreliosis, provides guidance in test selection and interpretation, and highlights future directions.
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Skogman BH, Wilhelmsson P, Atallah S, Petersson AC, Ornstein K, Lindgren PE. Lyme neuroborreliosis in Swedish children-PCR as a complementary diagnostic method for detection of Borrelia burgdorferi sensu lato in cerebrospinal fluid. Eur J Clin Microbiol Infect Dis 2021; 40:1003-1012. [PMID: 33387122 PMCID: PMC8084766 DOI: 10.1007/s10096-020-04129-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/13/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate polymerase chain reaction (PCR) as a diagnostic method for the detection of Borrelia burgdorferi s.l. in CSF of Swedish children with LNB. This study was performed retrospectively on CSF and serum samples collected from children evaluated for LNB (n = 233) and controls with other specific neurological disorders (n = 59) in a Swedish Lyme endemic area. For anti-Borrelia antibody index, the IDEIA Lyme Neuroborreliosis kit (Oxoid) was used. Two in-house real-time PCR assays targeting the 16S rRNA gene were evaluated (TaqMan® and LUX™). Among patients classified as LNB cases (n = 102), five children (5%) were Borrelia PCR-positive in CSF with the TaqMan® assay. In the Non-LNB group (n = 131), one patient was Borrelia PCR positive with the TaqMan® assay. Among controls (n = 59), all CSF samples were PCR negative. When amplifying and sequencing ospA, we found B. garinii (n = 2), B. afzelii (n = 2), B. bavariensis (n = 1), and one untypable (n = 1). With the LUX™ technology, all CSF samples were PCR negative. The TaqMan® assay could detect only few cases (n = 6) of B. burgdorferi s.l. in CSF among children with LNB and the sensitivity was very low (5%). However, using larger CSF volumes and centrifugation of samples, the PCR technique could still be useful as a complementary diagnostic method when evaluating LNB. Furthermore, detection of spirochete DNA in clinical matrices, including CSF, is the method of choice for studying epidemiological aspects of LNB, a tick-borne emerging disease.
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Affiliation(s)
- Barbro H Skogman
- Center for Clinical Research Dalarna - Uppsala University, Region Dalarna County, Falun, Sweden. .,Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
| | - Stephanie Atallah
- Department of infectious diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Katarina Ornstein
- Ystad Hospital, Skåne University Health Care, Region Skåne, Ystad, Sweden
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Division of Clinical Microbiology, Laboratory Medicine, Ryhov County Hospital, Jönköping, Sweden
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6
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Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz HI, Hunfeld KP, Krause A, Ruf B, Dersch R. Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc03. [PMID: 32341686 PMCID: PMC7174852 DOI: 10.3205/000279] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Indexed: 12/12/2022]
Abstract
Lyme borreliosis is the most common tick-borne infectious disease in Europe. A neurological manifestation occurs in 3–15% of infections and can manifest as polyradiculitis, meningitis and (rarely) encephalomyelitis. This S3 guideline is directed at physicians in private practices and clinics who treat Lyme neuroborreliosis in children and adults. Twenty AWMF member societies, the Robert Koch Institute, the German Borreliosis Society and three patient organisations participated in its development. A systematic review and assessment of the literature was conducted by the German Cochrane Centre, Freiburg (Cochrane Germany). The main objectives of this guideline are to define the disease and to give recommendations for the confirmation of a clinically suspected diagnosis by laboratory testing, antibiotic therapy, differential diagnostic testing and prevention.
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Affiliation(s)
| | | | | | - Volker Fingerle
- German Society for Hygiene and Microbiology (DGHM), Münster, Germany
| | - Hans-Iko Huppertz
- German Society of Paediatrics and Adolescent Medicine (DGKJ), Berlin, Germany.,German Society of Paediatric Infectology (DGPI), Berlin, Germany
| | - Klaus-Peter Hunfeld
- The German United Society of Clinical Chemistry and Laboratory Medicine (DGKL), Bonn, Germany.,INSTAND e.V., Düsseldorf, Germany
| | | | - Bernhard Ruf
- German Society of Infectious Diseases (DGI), Berlin, Germany
| | - Rick Dersch
- German Society of Neurology (DGN), Berlin, Germany.,Cochrane Germany, Faculty of Medicine, University of Freiburg, Germany
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Zhou Y, Qin S, Sun M, Tang L, Yan X, Kim TK, Caballero J, Glusman G, Brunkow ME, Soloski MJ, Rebman AW, Scavarda C, Cooper D, Omenn GS, Moritz RL, Wormser GP, Price ND, Aucott JN, Hood L. Measurement of Organ-Specific and Acute-Phase Blood Protein Levels in Early Lyme Disease. J Proteome Res 2019; 19:346-359. [PMID: 31618575 DOI: 10.1021/acs.jproteome.9b00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lyme disease results from infection of humans with the spirochete Borrelia burgdorferi. The first and most common clinical manifestation is the circular, inflamed skin lesion referred to as erythema migrans; later manifestations result from infections of other body sites. Laboratory diagnosis of Lyme disease can be challenging in patients with erythema migrans because of the time delay in the development of specific diagnostic antibodies against Borrelia. Reliable blood biomarkers for the early diagnosis of Lyme disease in patients with erythema migrans are needed. Here, we performed selected reaction monitoring, a targeted mass spectrometry-based approach, to measure selected proteins that (1) are known to be predominantly expressed in one organ (i.e., organ-specific blood proteins) and whose blood concentrations may change as a result of Lyme disease, or (2) are involved in acute immune responses. In a longitudinal cohort of 40 Lyme disease patients and 20 healthy controls, we identified 10 proteins with significantly altered serum levels in patients at the time of diagnosis, and we also developed a 10-protein panel identified through multivariate analysis. In an independent cohort of patients with erythema migrans, six of these proteins, APOA4, C9, CRP, CST6, PGLYRP2, and S100A9, were confirmed to show significantly altered serum levels in patients at time of presentation. Nine of the 10 proteins from the multivariate panel were also verified in the second cohort. These proteins, primarily innate immune response proteins or proteins specific to liver, skin, or white blood cells, may serve as candidate blood biomarkers requiring further validation to aid in the laboratory diagnosis of early Lyme disease.
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Affiliation(s)
- Yong Zhou
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Shizhen Qin
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Mingjuan Sun
- Institute for Systems Biology , Seattle , Washington 98109 , United States.,Second Military Medical University , Shanghai 200433 , China
| | - Li Tang
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Xiaowei Yan
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Taek-Kyun Kim
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Juan Caballero
- Molecular and Developmental Complexity Lab , Langebio-Cinvestav , Irapuato , Guanajuato 36821 , Mexico
| | - Gustavo Glusman
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Mary E Brunkow
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Mark J Soloski
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland 21093 , United States
| | - Alison W Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland 21093 , United States
| | - Carol Scavarda
- Division of Infectious Diseases, Department of Medicine , New York Medical College , Valhalla , New York 10595 , United States
| | - Denise Cooper
- Division of Infectious Diseases, Department of Medicine , New York Medical College , Valhalla , New York 10595 , United States
| | - Gilbert S Omenn
- Institute for Systems Biology , Seattle , Washington 98109 , United States.,Center for Computational Medicine & Bioinformatics , University of Michigan , Ann Arbor , Michigan 48109 , United States
| | - Robert L Moritz
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - Gary P Wormser
- Division of Infectious Diseases, Department of Medicine , New York Medical College , Valhalla , New York 10595 , United States
| | - Nathan D Price
- Institute for Systems Biology , Seattle , Washington 98109 , United States
| | - John N Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland 21093 , United States
| | - Leroy Hood
- Institute for Systems Biology , Seattle , Washington 98109 , United States.,Providence St. Joseph Health , Seattle , Washington 98109 , United States
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8
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Pilot Study of Immunoblots with Recombinant Borrelia burgdorferi Antigens for Laboratory Diagnosis of Lyme Disease. Healthcare (Basel) 2018; 6:healthcare6030099. [PMID: 30110913 PMCID: PMC6163603 DOI: 10.3390/healthcare6030099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/07/2018] [Accepted: 08/10/2018] [Indexed: 12/15/2022] Open
Abstract
Accurate laboratory diagnosis of Lyme disease (Lyme borreliosis), caused by the spirochete Borrelia burgdorferi (BB), is difficult and yet important to prevent serious disease. The US Centers for Disease Control and Prevention (CDC) presently recommends a screening test for serum antibodies followed by confirmation with a more specific Western blot (WB) test to detect IgG and IgM antibodies against antigens in whole cell lysates of BB. Borrelia species related to BB cause tick-borne relapsing fever (TBRF). TBRF is increasingly recognized as a health problem in the US and occurs in areas where Lyme disease is prevalent. The two groups of Borrelia share related antigens. We have developed a modified WB procedure termed the Lyme immunoblots (IBs) using recombinant antigens from common strains and species of the BB sensu lato complex for serological diagnosis of Lyme disease. A reference collection of 178 sera from 26 patients with and 152 patients without Lyme disease were assessed by WB and IB in a blinded manner using either criteria for positive antibody reactions recommended by the CDC or criteria developed in-house. The sensitivity, specificity, positive and negative predictive values obtained with the reference sera suggest that the Lyme IB is superior to the Lyme WB for detection of specific antibodies in Lyme disease. The Lyme IB showed no significant reaction with rabbit antisera produced against two Borrelia species causing TBRF in the US, suggesting that the Lyme IB may be also useful for excluding TBRF.
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9
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Shah JS, D' Cruz I, Ward S, Harris NS, Ramasamy R. Development of a sensitive PCR-dot blot assay to supplement serological tests for diagnosing Lyme disease. Eur J Clin Microbiol Infect Dis 2017; 37:701-709. [PMID: 29282568 PMCID: PMC5978905 DOI: 10.1007/s10096-017-3162-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
Laboratory diagnosis of Lyme disease is difficult and presently dependent on detecting Borrelia burgdorferi-specific antibodies in patient serum with the disadvantage that the immune response to B. burgdorferi can be weak or variable, or alternatively, the slow and inefficient culture confirmation of B. burgdorferi. PCR tests have previously shown poor sensitivity and are not routinely used for diagnosis. We developed a sensitive and specific Lyme Multiplex PCR-dot blot assay (LM-PCR assay) applicable to blood and urine samples to supplement western blot (WB) serological tests for detecting B. burgdorferi infection. The LM-PCR assay utilizes specific DNA hybridization to purify B. burgdorferi DNA followed by PCR amplification of flagellin and OspA gene fragments and their detection by southern dot blots. Results of the assay on 107 and 402 clinical samples from patients with suspected Lyme disease from Houston, Texas or received at the IGeneX laboratory in Palo Alto, California, respectively, were analyzed together with WB findings. The LM-PCR assay was highly specific for B. burgdorferi. In the Texas samples, 23 (21.5%) patients antibody-negative in WB assays by current US Centers for Disease Control (CDC) recommended criteria were positive by LM-PCR performed on urine, serum or whole blood samples. With IGeneX samples, of the 402 LM-PCR positive blood samples, only 70 met the CDC criteria for positive WBs, while 236 met IGeneX criteria for positive WB. Use of the LM-PCR assay and optimization of current CDC serological criteria can improve the diagnosis of Lyme disease.
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Affiliation(s)
- J S Shah
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA.
| | - I D' Cruz
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - S Ward
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - N S Harris
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
| | - R Ramasamy
- IGeneX Inc., 795 San Antonio Road, Palo Alto, CA, 94303, USA
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Lager M, Faller M, Wilhelmsson P, Kjelland V, Andreassen Å, Dargis R, Quarsten H, Dessau R, Fingerle V, Margos G, Noraas S, Ornstein K, Petersson AC, Matussek A, Lindgren PE, Henningsson AJ. Molecular detection of Borrelia burgdorferi sensu lato - An analytical comparison of real-time PCR protocols from five different Scandinavian laboratories. PLoS One 2017; 12:e0185434. [PMID: 28937997 PMCID: PMC5609768 DOI: 10.1371/journal.pone.0185434] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Lyme borreliosis (LB) is the most common tick transmitted disease in Europe. The diagnosis of LB today is based on the patient´s medical history, clinical presentation and laboratory findings. The laboratory diagnostics are mainly based on antibody detection, but in certain conditions molecular detection by polymerase chain reaction (PCR) may serve as a complement. Aim The purpose of this study was to evaluate the analytical sensitivity, analytical specificity and concordance of eight different real-time PCR methods at five laboratories in Sweden, Norway and Denmark. Method Each participating laboratory was asked to analyse three different sets of samples (reference panels; all blinded) i) cDNA extracted and transcribed from water spiked with cultured Borrelia strains, ii) cerebrospinal fluid spiked with cultured Borrelia strains, and iii) DNA dilution series extracted from cultured Borrelia and relapsing fever strains. The results and the method descriptions of each laboratory were systematically evaluated. Results and conclusions The analytical sensitivities and the concordance between the eight protocols were in general high. The concordance was especially high between the protocols using 16S rRNA as the target gene, however, this concordance was mainly related to cDNA as the type of template. When comparing cDNA and DNA as the type of template the analytical sensitivity was in general higher for the protocols using DNA as template regardless of the use of target gene. The analytical specificity for all eight protocols was high. However, some protocols were not able to detect Borrelia spielmanii, Borrelia lusitaniae or Borrelia japonica.
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Affiliation(s)
- Malin Lager
- Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- * E-mail:
| | - Maximilian Faller
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Peter Wilhelmsson
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
| | - Vivian Kjelland
- Faculty of Engineering and Science, Department of Natural Sciences, University of Agder, Kristiansand, Norway
- Research Unit, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Åshild Andreassen
- Division of Infectious Disease Control, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Rimtas Dargis
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Hanne Quarsten
- Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Ram Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Volker Fingerle
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Gabriele Margos
- German National Reference Centre for Borrelia, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Sølvi Noraas
- Department of Medical Microbiology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | | | - Andreas Matussek
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
- Karolinska University Laboratory, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Per-Eric Lindgren
- Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Sweden
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11
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Remy MM, Schöbi N, Kottanattu L, Pfister S, Duppenthaler A, Suter-Riniker F. Cerebrospinal fluid CXCL13 as a diagnostic marker of neuroborreliosis in children: a retrospective case-control study. J Neuroinflammation 2017; 14:173. [PMID: 28859668 PMCID: PMC5580331 DOI: 10.1186/s12974-017-0948-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/24/2017] [Indexed: 02/07/2023] Open
Abstract
Background Lyme neuroborreliosis (LNB) is a frequent manifestation of Lyme disease in children and its current diagnosis has limitations. The elevation of the chemokine CXCL13 in the cerebrospinal fluid (CSF) of adult patients with LNB has been demonstrated and suggested as a new diagnostic marker. Our aim was to evaluate this marker in the CSF of children with suspected LNB and to determine a CXCL13 cut-off concentration that would discriminate between LNB and other central nervous system (CNS) infections. Methods For this single-center retrospective case-control study we used a diagnostic-approved ELISA to measure CXCL13 concentrations in the CSF of 185 children with LNB suspicion at presentation. Patients were classified into definite LNB (cases), non-LNB (controls with other CNS affections), and possible LNB. A receiver-operating characteristic curve was generated by comparison of cases and controls. Results CXCL13 was significantly elevated in the CSF of 53 children with definite LNB (median 774.7 pg/ml) compared to 91 control patients (median 4.5 pg/ml, p < 0.001). A cut-off of 55 pg/ml resulted in a sensitivity of 96.7% and a specificity of 98.1% for the diagnosis of definite LNB and the test exhibited a diagnostic odds ratio of 1525.3. Elevated CSF CXCL13 levels were also detected in three controls with viral meningitis (enterovirus n = 1, varicella-zoster virus n = 2) while other CNS affections such as idiopathic facial palsy did not lead to CXCL13 elevation. Of the 41 patients with possible LNB, 27% had CXCL13 values above the cut-off of 55 pg/ml (median 16.7 pg/ml). Conclusions CSF CXCL13 is highly elevated in children during early LNB as previously shown in adults. CXCL13 is a highly sensitive and specific marker that helps to differentiate LNB from other CNS affections in children.
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Affiliation(s)
- M M Remy
- Institute of Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland.
| | - N Schöbi
- Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - L Kottanattu
- Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Pfister
- Institute of Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland
| | - A Duppenthaler
- Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Suter-Riniker
- Institute of Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001, Bern, Switzerland
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12
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Djukic M, Larsen J, Lingor P, Nau R. Unilateral phrenic nerve lesion in Lyme neuroborreliosis. BMC Pulm Med 2013; 13:4. [PMID: 23327473 PMCID: PMC3566936 DOI: 10.1186/1471-2466-13-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background Among a variety of more common differential diagnoses, the aetiology of acute respiratory failure includes Lyme neuroborreliosis. Case presentation We report an 87-years old huntsman with unilateral phrenic nerve palsy as a consequence of Lyme neuroborreliosis. Conclusion Although Lyme neuroborreliosis is a rare cause of diaphragmatic weakness, it should be considered in the differential workup because of its potentially treatable nature.
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Affiliation(s)
- Marija Djukic
- Department of Neuropathology, University Medical Centre Goettingen, Robert-Koch-Str, 40, 37075 Goettingen, Germany.
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13
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Abstract
Borrelia burgdorferi infection, the tick-borne spirochetosis known as Lyme disease or Lyme borreliosis, involves the nervous system (neuroborreliosis) in 10% to 15% of patients. Common manifestations include lymphocytic meningitis, cranial neuritis, mononeuropathy multiplex, and painful radiculoneuritis. Rare patients develop inflammation in the brain or spinal cord. Regardless of the form of involvement, neuroborreliosis can be microbiologically cured in virtually all patients using standard 2- to 4-week antimicrobial regimens. Oral regimens appear to be as effective as parenteral ones in most instances. Although patients ill with Lyme disease may have concomitant cognitive or memory difficulty, these symptoms are not specific to neuroborreliosis and, when present in isolation, should not be viewed as suggestive of this diagnosis. When present as part of Lyme disease, they do not require additional or different treatment.
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14
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Djukic M, Schmidt-Samoa C, Lange P, Spreer A, Neubieser K, Eiffert H, Nau R, Schmidt H. Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol 2011; 259:630-6. [PMID: 21898139 PMCID: PMC3319903 DOI: 10.1007/s00415-011-6221-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 08/06/2011] [Accepted: 08/10/2011] [Indexed: 11/24/2022]
Abstract
Presence of BB-specific antibodies in the cerebrospinal fluid (CSF) with evidence of their intrathecal production in conjunction with the white cell count in the CSF and typical clinical symptoms is the traditional diagnostic gold standard of Lyme neuroborreliosis (LNB). Few data are available on the CSF lactate concentration in European adults with the diagnosis of acute LNB. The objective of the study was to investigate the CSF changes during acute LNB. Routine CSF parameters [leukocyte count, protein, lactate and albumin concentrations, CSF/serum quotients of albumin (QAlb), IgG, IgA and IgM, and oligoclonal IgG bands] and the Borrelia burgdorferi (BB)-specific antibody index were retrospectively studied in relation to the clinical presentation in patients diagnosed with acute LNB. A total of 118 patients with LNB were categorized into the following groups according to their symptoms at presentation; group 1: polyradiculoneuritis (Bannwarth’s syndrome), group 2: isolated facial palsy and group 3: predominantly meningitic course of the disease. In addition to the CSF of patients with acute LNB, CSF of 19 patients with viral meningitis (VM) and 3 with neurolues (NL) were analyzed. There were 97 patients classified with definite LNB, and 21 as probable LNB. Neck stiffness and fever were reported by 15.3% of patients. Most of these patients were younger than 50 years. Polyradiculoneuritis was frequently found in patients older than 50 years. Lymphopleocytosis was found in all patients. Only 5 patients had a CSF lactate ≥3.5 mmol/l, and the mean CSF lactate level was not elevated (2.1 ± 0.6 mmol/l). The patients with definite LNB had significantly higher lactate levels than patients with probable LNB. Elevated lactate levels were accompanied by fever and headache. In the Reiber nomograms, intrathecal immunoglobulin synthesis was found for IgM in 70.2% followed by IgG in 19.5%. Isoelectric focussing detected an intrathecal IgG synthesis in 83 patients (70.3%). Elevated BB AIs in the CSF were found in 97 patients (82.2%). Patients with VM showed lower CSF protein concentration and CSF/serum quotients of albumin than LNB patients. In acute LNB, all patients had elevated cerebrospinal fluid (CSF) leukocyte counts. In contrast to infections by other bacteria, CSF lactate was lower than 3.5 mmol/l in all but 5 patients. The CSF findings did not differ between polyradiculoneuritis, facial palsy, and meningitis. The CSF in LNB patients strongly differed from CSF in VM patients with respect to protein concentration and the CSF/serum albumin quotient.
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Affiliation(s)
- Marija Djukic
- Department of Geriatrics, Evangelisches Krankenhaus Goettingen-Weende, An der Lutter 24, 37075 Goettingen, Germany.
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15
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Abstract
Lyme disease is the most common vector-borne illness in the United States and is also endemic in Europe and Asia. It is caused by the spirochete Borrelia burgdorferi and transmitted by the bite of the Ixodes (deer) tick. It occurs most frequently during spring and summer and may involve the skin, nervous system, heart, and joints. This article reviews the pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of Lyme disease.
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Rauter C, Mueller M, Diterich I, Zeller S, Hassler D, Meergans T, Hartung T. Critical evaluation of urine-based PCR assay for diagnosis of Lyme borreliosis. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2005; 12:910-7. [PMID: 16085907 PMCID: PMC1182183 DOI: 10.1128/cdli.12.8.910-917.2005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many approaches were made in recent years to establish urine PCR as a diagnostic tool for Lyme borreliosis, but results are contradictory. In the present study, a standardized protocol spiking urine from healthy donors with a defined amount of whole Borrelia or Borrelia DNA was established. The development of a nested real-time PCR targeting ospA enabled a highly sensitive and quantitative analysis of these samples. We show the following. (i) Storage of spiked urine samples for up to 6 months at--20 degrees C had no negative effect on spike recovery. (ii) Centrifugation of 10 ml of urine at 40,000 x g for 30 min resulted in a concentration of both spikes, i.e., whole Borrelia and DNA. (iii) The inhibition of DNA spike recovery in 48% (11 of 23 samples) of urine samples tested could be attributed to nuclease activity. This was abrogated by alkalizing the urine or by working with the samples on ice. Despite optimized conditions, analysis of urine samples of 12 patients with erythema migrans, the clinical stage considered to be associated with the highest bacterial load, revealed a positive result in only one sample. All 12 samples were negative by an alternative PCR targeting flagellin. The results of our study support doubts that urine is a suitable material for diagnosis of Lyme borreliosis.
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Affiliation(s)
- Carolin Rauter
- Biochemical Pharmacology, Faculty of Biology, University of Konstanz, Konstanz, Germany
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17
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Abstract
A large amount of knowledge has been acquired since the original descriptions of Lyme borreliosis (LB) and of its causative agent, Borrelia burgdorferi sensu stricto. The complexity of the organism and the variations in the clinical manifestations of LB caused by the different B. burgdorferi sensu lato species were not then anticipated. Considerable improvement has been achieved in detection of B. burgdorferi sensu lato by culture, particularly of blood specimens during early stages of disease. Culturing plasma and increasing the volume of material cultured have accomplished this. Further improvements might be obtained if molecular methods are used for detection of growth in culture and if culture methods are automated. Unfortunately, culture is insensitive in extracutaneous manifestations of LB. PCR and culture have high sensitivity on skin samples of patients with EM whose diagnosis is based mostly on clinical recognition of the lesion. PCR on material obtained from extracutaneous sites is in general of low sensitivity, with the exception of synovial fluid. PCR on synovial fluid has shown a sensitivity of up to >90% (when using four different primer sets) in patients with untreated or partially treated Lyme arthritis, making it a helpful confirmatory test in these patients. Currently, the best use of PCR is for confirmation of the clinical diagnosis of suspected Lyme arthritis in patients who are IgG immunoblot positive. PCR should not be used as the sole laboratory modality to support a clinical diagnosis of extracutaneous LB. PCR positivity in seronegative patients suspected of having late manifestations of LB most likely represents a false-positive result. Because of difficulties in direct methods of detection, laboratory tests currently in use are mainly those detecting antibodies to B. burgdorferi sensu lato. Tests used to detect antibodies to B. burgdorferi sensu lato have evolved from the initial formats as more knowledge on the immunodominant antigens has been collected. The recommendation for two-tier testing was an attempt to standardize testing and improve specificity in the United States. First-tier assays using whole-cell sonicates of B. burgdorferi sensu lato need to be standardized in terms of antigen composition and detection threshold of specific immunoglobulin classes. The search for improved serologic tests has stimulated the development of recombinant protein antigens and the synthesis of specific peptides from immunodominant antigens. The use of these materials alone or in combination as the source of antigen in a single-tier immunoassay may someday replace the currently recommended two-tier testing strategy. Evaluation of these assays is currently being done, and there is evidence that certain of these antigens may be broadly cross-reactive with the B. burgdorferi sensu lato species causing LB in Europe.
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Affiliation(s)
- Maria E Aguero-Rosenfeld
- Department of Pathology, Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA.
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18
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Debiasi RL, Tyler KL. Molecular methods for diagnosis of viral encephalitis. Clin Microbiol Rev 2005; 17:903-25, table of contents. [PMID: 15489354 PMCID: PMC523566 DOI: 10.1128/cmr.17.4.903-925.2004] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hundreds of viruses cause central nervous system (CNS) disease, including meningoencephalitis and postinfectious encephalomyelitis, in humans. The cerebrospinal fluid (CSF) is abnormal in >90% of cases; however, routine CSF studies only rarely lead to identification of a specific etiologic agent. Diagnosis of viral infections of the CNS has been revolutionized by the advent of new molecular diagnostic technologies to amplify viral nucleic acid from CSF, including PCR, nucleic acid sequence-based amplification, and branched-DNA assay. PCR is ideally suited for identifying fastidious organisms that may be difficult or impossible to culture and has been widely applied for detection of both DNA and RNA viruses in CSF. The technique can be performed rapidly and inexpensively and has become an integral component of diagnostic medical practice in the United States and other developed countries. In addition to its use for identification of etiologic agents of CNS disease in the clinical setting, PCR has also been used to quantitate viral load and monitor duration and adequacy of antiviral drug therapy. PCR has also been applied in the research setting to help discriminate active versus postinfectious immune-mediate disease, identify determinants of drug resistance, and investigate the etiology of neurologic disease of uncertain cause. This review discusses general principles of PCR and reverse transcription-PCR, including qualitative, quantitative, and multiplex techniques, with comment on issues of sensitivity, specificity, and positive and negative predictive values. The application of molecular diagnostic methods for diagnosis of specific infectious entities is reviewed in detail, including viruses for which PCR is of proven efficacy and is widely available, viruses for which PCR is less widely available or for which PCR has unproven sensitivity and specificity, and nonviral entities which can mimic viral CNS disease.
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Affiliation(s)
- Roberta L Debiasi
- Department of Pediatrics, Division of Infectious Diseases, University of Colorado Health Sciences Center, Box A036/B055, Denver, CO 80262, USA.
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Bergmann AR, Schmidt BL, Derler AM, Aberer E. Importance of sample preparation for molecular diagnosis of lyme borreliosis from urine. J Clin Microbiol 2002; 40:4581-4. [PMID: 12454156 PMCID: PMC154646 DOI: 10.1128/jcm.40.12.4581-4584.2002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Urine PCR has been used for the diagnosis of Borrelia burgdorferi infection in recent years but has been abandoned because of its low sensitivity and the irreproducibility of the results. Our study aimed to analyze technical details related to sample preparation and detection methods. Crucial for a successful urine PCR were (i) avoidance of the first morning urine sample; (ii) centrifugation at 36,000 x g; and (iii) the extraction method, with only DNAzol of the seven different extraction methods used yielding positive results with patient urine specimens. Furthermore, storage of frozen urine samples at -80 degrees C reduced the sensitivity of a positive urine PCR result obtained with samples from 72 untreated erythema migrans (EM) patients from 85% in the first 3 months to <30% after more than 3 months. Bands were detected at 276 bp on ethidium bromide-stained agarose gels after amplification by a nested PCR. The specificity of bands for 32 of 33 samples was proven by hybridization with a GEN-ETI-K-DEIA kit and for a 10 further positive amplicons by sequencing. By using all of these steps to optimize the urine PCR technique, B. burgdorferi infection could be diagnosed by using urine samples from EM patients with a sensitivity (85%) substantially better than that of serological methods (50%). This improved method could be of future importance as an additional laboratory technique for the diagnosis of unclear, unrecognized borrelia infections and diseases possibly related to Lyme borreliosis.
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Affiliation(s)
- A. R. Bergmann
- Department of Dermatology, Karl Franzens University Hospital, A-8036 Graz, Department of Dermatology, Lainz Hospital, Vienna, Austria
| | - B. L. Schmidt
- Department of Dermatology, Karl Franzens University Hospital, A-8036 Graz, Department of Dermatology, Lainz Hospital, Vienna, Austria
| | - A.-M. Derler
- Department of Dermatology, Karl Franzens University Hospital, A-8036 Graz, Department of Dermatology, Lainz Hospital, Vienna, Austria
| | - E. Aberer
- Department of Dermatology, Karl Franzens University Hospital, A-8036 Graz, Department of Dermatology, Lainz Hospital, Vienna, Austria
- Corresponding author. Mailing address: Auenbrugger Platz 8, A-8036 Graz, Austria. Phone: 0043/316-385-80317. Fax: 0043/316-385-2466. E-mail:
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